The Latest Numbers in Medicine and Finance

MARCH 01, 2012

Jeff Brown, MD

— The January 23 issue of the Archives of Internal Medicine had a revelatory article showing that referrals to specialists increased a whopping 156% from 1999 to 2009. That is, from 41 million to 105 million; PCPs from 22 million to 51 million and specialists from 11 million to 38 million. Visits overall went from 841 million to 1.1 billion. These numbers are staggering when you start thinking about what a major cost driver these increased referrals are and raise questions of their appropriateness and effectiveness. These issues fairly cry out for political intervention; and physicians' responsibilities, both individually and severally, are a major factor. What are we going to do about it?

— Several studies have shown that 25% of individual variation in assuming portfolio risk is genetic. Specifically, it relates to how much dopamine a person tends to release in response to risk. It's not too much of a stretch to see how applying for a Wall Street trading job in the future will include a DNA analysis.

— If you would like to have a yardstick to measure "how you are doing" in the net worth versus age scale, let me suggest Your Money Ratios: 8 Simple Tools for Financial Security by Charles Farrell, JD, LLM. One example is that, based upon analysis, your net worth at age 35 should roughly equal your annual income. At 45 you should have three to four times your income as a net worth figure to "keep you on target." Assets at 55 should be six to eight times income and at 65 you should equal 10 to 12 times income. The implication is that these ratios are a suggested minimum; if you have more, "that is a good thing," to paraphrase Martha Stewart.

— If you are concerned about how to get going in investing, consider joining or forming an investment club. Your group can agree upon a monthly contribution for each person to pony up. You organize a comfortable structure, study, learn and listen. Invite guest speakers or visit a target company. It's important to share the work, focus on your long-term rewards and have some fun along the way. For help, Google investment clubs or look for books such as Investment Clubs for Dummies.

— The public is currently being bombarded by "save 15% on car insurance by calling us" ads. You probably can do just as well by calling your existing carrier, who knows full well what's going on, and asking for a review and a better deal. They badly want to keep you and you are likely going to save a few bucks. They will give you a discount for a clean driving record; commuting fewer miles; strong credit; being married; being over 50; living in a small town; driving a staid sedan; having driving lights, antilock brakes and such; etc. Who knows, it might even help if you are a gecko....

— In 1980, 46% of employed Americans had a pension promised to them. This year the number is down to 16%. No surprise there.

— A survey in Worth magazine showed that 76% of wealthy Americans think that prenuptial agreements are important, but it turns out that only 17% of them actually have asked for one. Why, you ask? First of all, the message sent by asking is not encouraging and secondly, we all share the over confidence of the affianced. The same survey also showed that 12% were worried that their marriages were not going to last. Depending upon your point of view, that is either a pessimistic start, or an optimistic take on the widely reported "50%" divorce rate. Which, incidentally, is not accurate for mature, college-educated people. The much lower rate around 15% averages to 50% only when the very young and lower income marriages are folded in.

— FYI, Japan has led the world for five years in Michelin three-star ratings, not France. For example, Tokyo now has 16 of Japan's total of 32 and Paris has 10 of its national 25. By the way, if you ever have the opportunity to indulge in a French 3 star restaurant, the experience is, in my opinion, astonishing — including the ambiance, the culinary sensations and the financial wallop at the end.

— The gender struggle in medicine, although muted in recent years, continues. The average new female doctor starts at an average $17,000 less than her male colleague. And only 18% of full medical professors are women as are only 12% of department chairs. This is in spite of the fact that females account for 50% of medical school enrollment for the last 10 years and 30% over the last 25 years. But then this all is not news to you, ladies.

— In other sociology developments, the most recent census showed that only 51% of American adults are now married and 28% of households consist of just one person. Single-person households are up from just 14% in 1960. In Manhattan it has reached 50% (60% in Stockholm!). No wonder we use Facebook so much, we're paradoxically becoming more isolated as the population rises.